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malignant_lymphedema

Malignant Lymphedema

What is Malignant Lymphedema?

Lymphedema caused by an impaired lymph flow due to malignant tumor infiltratration and blockage or compression of lymphatic vessels and lymph nodes.

This is different then secondary lymphedema which is caused by removal of lymph nodes, damage to the lymph system from trauma; cancer treament, biopsy. See risk factors for lymphedema for causes of secondary lymphedema. Secondary lymphedema tends to develop slowly over an extended period of time versus the rapid development of malignant lymphedema.

Diagnosis

Physical exam and history which typically reveal rapid onset, neuropathic pain, weakness, skin discoloration or unusual lesions, proximal or genital location, lymphadenopathy, tense edema (1)

*Important to understand that malignant lymphedema develops quickly, can be quite painful and has a firm tissue texture. Malignant lymphedema in the abdominal/truncal regions can also result in pleural effusions, so patients experiencing this should be tested.

Diagnosis can be achieved through ultrasound, CT, MRI, lymphoscintigraphy.

Treatment

Palliative or curative treatment of tumor with radiation, surgery or chemotherapy.

If terminal then no contraindication to MLD and compression bandages or garments.

If not terminal, then treat with bandages and garments alone.

Primary treatment focuses on resolution of the tumor and/or malignancy causing the lymphatic obstruction.

FDG PET in the differentiation of benign from malignant lymphedema

J Nucl Med. 2007

Mijin Yun1, Taesung Kim1, Arthur Cho1 and Jongdoo Lee1 1 Yonsei University College of Medicine, Seoul, South Korea 1278

Objectives:

This study was undertaken to assess the role of FDG PET in the differentiation of benign from malignant lymphedema in patients with a history of various malignancies.

Methods:

We performed a retrospective review of medical records to select patients with lymphedema in one of the extremities who had underdone FDG PET imaging. Twenty three patients (18F: 5M, mean age: 60, age range: 38-75) were included in this study. Of the 23 patients, 7 were diagnosed with breast cancer, 4 with cancer of uterine cervix, 4 with colorectal cancer, 2 with ovarian cancer, 2 with soft tissue sarcoma, and 1 of the following diseases; skin cancer, melanoma, lymphoma, and endometrial cancer. All patients had undergone FDG PET to evaluate for tumor recurrence or surveillance. If the degree of FDG uptake in the lesion was less than the uptake in the liver (mild), it was considered to be negative. Conversely, if the uptake in the lesion was similar to (moderate) or greater than that in the liver (high), the findings considered positive.

Results:

Of the 23 patients, 8 showed upper extremity lymphedema and 15 lower extremity lymphedema. There were 9 patients with positive FDG uptake in the ipsilateral axilla, groin or pelvis. All patients except for one were found to have recurrent diseases which were responsible for lymphedema. In addition, PET was useful in detecting recurrent diseases other than the recurrence in the axilla, groin, or pelvis in 6 of the 8 patients. There was a false positive patient showing a focus of increased FDG uptake in the Rt. pelvis. The lesion was not confirmed by other imaging modalities or follow up, which could have been due to physiologic bowel uptake. The other 14 patients showed no increase of FDG uptake proximal to the extremities with lymphedema. No patient was proven to have recurrent disease.

Conclusions:

It can be difficult to detect malignant causes of lymphedema by anatomical imaging because of altered anatomy after surgery and/or radiation therapy. Based on our study, FDG PET seems to be extremely useful in the differentiation of benign from malignant lymphedema. It has potential in early diagnosis and in initiate proper treatment of malignant lymphedema, which can change patient survival and prevent the progression of diseases.

Journal of Nuclear Medicine

Secondary malignant lymphedema

Wien Med Wochenschr. 2006 May

Keywords

Malignant lymphedema - Complications - Physical treatment

Soucek-Hadwiger B, Döller W. Abteilung für Innere Medizin, Landesklinikum Thermenregion Baden, Osterreich. bettina.soucek-hadwiger@baden.lknoe.at

The diagnosis of a secondary malignant lymphoedema which is caused by tumor infiltration or tumor compression is a very important sign for an unknown primary, but also for a tumor relapse. It is a big challenge, because it is often associated with a long story of woe, severe pain and a big reduction in mobility. Only an early diagnosis and introduction of a tumor-specific therapy is able to prevent the progress of this disease. As the secondary lymphedema is a chronic progressive disease, the early beginning of the “Complex physical Oedematherapy” is necessary, which consists of a combination of manual lymph drainage, compression by the use of bandages and special stockings for compression, physical training to improve mobility, dermatological care and drug therapy. Lymphedema is a chronic incurable disease. Therefore the therapeutic goal is to reach a stable disease without symptoms, which means reducing the lymphedema to “Stadium 0, latent stage”.

Springer Link

Diagnosis and therapy of Malignant Lymphedema

Rüger K Fachklinik für Lymphologie und Odemkrankheiten, St. Blasien.

In addition to the typical clinical symptoms, the diagnosis “malignant lymphedema” also requires the confirmation of a tumor or a metastasis obstructing lymph flow. With the standard physical treatment of edema described by Asdonk successful clinical management of malignant lymphedema is also possible. The sole contraindication of manual lymph drainage is, we believe, locoregional tumor recurrence, which can be completely eliminated by the immediate initiation of radical tumor treatment. The tumor recurrence is the result not of falsely indicated manual lymph drainage, but of inadequate primary treatment that leaves behind residual tumor tissue, the early detection of which still remains an unresolved problem. Manual lymph drainage is indispensable for improving the quality of life of tumor patients with lymphedema.

Medscape

Secondary malignant lymphedema in head and neck tumors

Wien Med Wochenschr. 2008

Hammerl B, Döller W. Station für Palliativmedizin, 5. Medizinische Abteilung mit Onkologie, Krankenhaus Hietzing, Wien, Osterreich. bernhard.hammerl@wienkav.at

Keywords: Secondary malignant lymphedema - Head–neck cancer - Selen - Sandostatin

The occurrence of edema is a serious problem of patients suffering from cancer and may have various causes. Particularly, the secondary malignant lymphedema poses a special threat to patients. In some cases, it indicates the progression of illness, and in fact also results in mutilating physical changes, which add to the already existing impairments caused by the cancer disease. So far therapeutic interventions are limited. Current management consists of physical therapy and pharmacological interventions. There are few powerful studies concerning the efficiency and hardly any concerning combined or comparative treatment in the literature. Most of them focus on the management of lymphedema in breast cancer patients. Preventive measures and supportive therapy are rarely being discussed. In this case report, we describe the successful use of Selen and Sandostatin in treating a facial edema of a patient with advanced head-neck cancer.

SpringerLink

FDG PET in the differentiation of benign from malignant lymphedema

2007

Mijin Yun1, Taesung Kim1, Arthur Cho1 and Jongdoo Lee1 1 Yonsei University College of Medicine, Seoul, South Korea

Objectives: This study was undertaken to assess the role of FDG PET in the differentiation of benign from malignant lymphedema in patients with a history of various malignancies.

Methods: We performed a retrospective review of medical records to select patients with lymphedema in one of the extremities who had underdone FDG PET imaging. Twenty three patients (18F: 5M, mean age: 60, age range: 38-75) were included in this study. Of the 23 patients, 7 were diagnosed with breast cancer, 4 with cancer of uterine cervix, 4 with colorectal cancer, 2 with ovarian cancer, 2 with soft tissue sarcoma, and 1 of the following diseases; skin cancer, melanoma, lymphoma, and endometrial cancer. All patients had undergone FDG PET to evaluate for tumor recurrence or surveillance. If the degree of FDG uptake in the lesion was less than the uptake in the liver (mild), it was considered to be negative. Conversely, if the uptake in the lesion was similar to (moderate) or greater than that in the liver (high), the findings considered positive.

Results: Of the 23 patients, 8 showed upper extremity lymphedema and 15 lower extremity lymphedema. There were 9 patients with positive FDG uptake in the ipsilateral axilla, groin or pelvis. All patients except for one were found to have recurrent diseases which were responsible for lymphedema. In addition, PET was useful in detecting recurrent diseases other than the recurrence in the axilla, groin, or pelvis in 6 of the 8 patients. There was a false positive patient showing a focus of increased FDG uptake in the Rt. pelvis. The lesion was not confirmed by other imaging modalities or follow up, which could have been due to physiologic bowel uptake. The other 14 patients showed no increase of FDG uptake proximal to the extremities with lymphedema. No patient was proven to have recurrent disease.

Conclusions: It can be difficult to detect malignant causes of lymphedema by anatomical imaging because of altered anatomy after surgery and/or radiation therapy.

Based on our study, FDG PET seems to be extremely useful in the differentiation of benign from malignant lymphedema. It has potential in early diagnosis and in initiate proper treatment of malignant lymphedema, which can change patient survival and prevent the progression of diseases.

SNMJournals

External Links

Patient Evaluation Differential Diagnosis & Co-morbidity(1)

Paul JB Stewart, MD, LANA-CLT 6th Internation NLN Conference Reno, Nevada

Related Lymphedema People Pages

Lymphedema People Resources

malignant_lymphedema.txt · Last modified: 2012/10/16 14:40 (external edit)